Pales diabetes intro Flashcards

Question

DKA. Clinical Presentation.

Answer 1

``` Mortality rate is 5-20% Onset over 1-2 days Polyuria-polydipsia Weakness Decreased appetite/nausea/vague abdominal pain Mental status changes - Confusion - Lethargy - Coma/convulsions ```

Answer 2

Depending on severity Signs of acidosis - Confusion - Lethargy - Kussmal Respiration - Fruity breath odor (acetone) Signs of dehydration - Oral membranes - Turgor of skin - Hypotension/tachycardia

Answer 3

``` High Blood Glucose (350-900) Low CO2/Bicarb/pH High Ketones/Acetone/Ketoacids High BUN and Creatinine High Serum K with decrease total body K Low Na (remember to correct it for high glucose (1 for each 100 over 100) High phosphorus In severe cases, signs of end organ damage maybe present. ```

Answer 4

I.V. Insulin***** I.V. Fluids (typically 100 ml/kg water deficit) Electrolytes replacements Ventilatory support in severe cases Switch iv insulin to subq injections upon resolution of DKA Normalization of anion gap is the most important indicator of resolution of DKA (as bicarb may remain low due to non-gap anion gap acidosis) Look for underlying reason to prevent it in the future

Answer 5

``` Hyperglycemia > 600 mg/dL. Serum osmolality > 310 mosm/kg. No acidosis; blood pH above 7.3. (because normal insulin) Serum bicarbonate > 15 mEq/L. Normal anion gap (under 14 mEq/L). ```

Answer 6

``` Hyperglycemia--> osmotic diuresis --> dehydration --> increased osmolality, decrease in free fluid --> hyperglycemia (solute concentration) Hypovolemic shock End organ damage - Coma - Renal Failure ```

Answer 7

Only type II diabetes (type I would be in DKA before they get to this state) Older patients with poor care, dementia, etc. Due to - non-compliance with medications - Acute infection/stress - Inability to increase oral intake in response to increase urinary output

Answer 8

Insidious onset Lethargy On exam severe state of dehydration (around 15% of ECF loss) Labs: very high glucose, no acidosis (unless lactic acidosis develops), K low, Na can be low, but more often high (corrected for glucose), elevated BUN/CR

Answer 9

``` I.V. fluids***** Some iv insulin Electrolyte replacement Ventilatory support needed at times Look for underlying reason to prevent it in the future ```

Answer 10

Initial symptoms can start with blood glucose less than 80 If patients have had high blood glucose for a long time, even normal glucose may cause some of the hypoglycemic symptoms Coma/passing out only if blood glucose is less than 50. Long term diabetics or patients on beta blockers may not have any initial symptoms until they pass out (hypoglycemia unawareness)

Answer 11

``` hungry headachy sweaty shaky confused dizzy grumpy anxious fast heartbeat ``` (remember: beta blockers can mask many of these symptoms)

Answer 12

Sympathoadrenal signs(glucose under 60 mg/dL) = sweating, tachycardia, tachypnea, anxiety, tremulousness, and nausea. More common in post prandial (PP) hypoglycemia. Neuroglycopenic signs(glucose under 50 mg/dL) = blurred vision, fatigue, dizziness, headache, confusion, seizures, coma, death. More common in fasting hypoglycemia.

Answer 13

``` Sugar orally if able or iv D50 Glucagon SQ injection Review the causes - Too much medication - Skipped meal - Exercises ```

Answer 14

Usually age 50-70 Insulin-secreting tumors of pancreatic origin Incidence of 1 to 4 per million. 90% are benign, solitary, intrapancreatic and less than 2 cm in diameter. Classically, symptoms are during fasting state or following exercise. Solitary tumor or associated with MEN 1 5 to 10% are malignant.

Answer 15

Dumping Syndrome. PPHH After Gastric Bypass Surgery. Insulin Autoimmune Syndrome (Hirata's disease) PPHH from insulin-receptor gene mutation.

Answer 16

Precipitous emptying of hyperosmolar carbohydrate-containing solutions into the small bowel --> rapid glucose absorption --> hyperglycemia --> and reactive hypoglycemia.

Answer 17

Enhanced postprandial insulin secretion from increased secretion of incretins

Answer 18

antibodies to endogenous insulin. Meal load --> hyperglycemia (antibodies bind insulin decreasing its bioavailabilty) --> high insulin level --> hypoglycemia (when insulin is released from antibodies binding)

Answer 19

Decreased degradation of insulin

Answer 20

Postprandial hypoglycemia No fasting hypoglycemia Island cell hyperplasia without a tumor Cause and mechanism is unknown

Answer 21

Syndrome of hypoglycemia associated with non- insulinoma neoplasm. Hepatomas, fibromas, fibrosarcomas, others Overproduction of IGF-2 by the tumor Mimics the fasting hypoglycemia characteristic of insulinoma Insulin level is low

Answer 22

72 hour fast (less if symptomatic hypoglycemia) - Q6h tests for glucose, insulin, C-peptide, and β-hydroxybutyrate - At the end of the 72 hr, inject glucagon and measure plasma glucose every 10 minutes three times Mixed Meal Diagnostic test After overnight fast and morning meal, check glucose, insulin, C-peptide, and proinsulin every 30 minutes for 5 hours after meal.

Answer 23

Symptoms and signs of hypoglycemia Low glucose at the time of the event (< 50 mg/dL) Reversal with correction of the hypoglycemia

Answer 24

``` Insulin antibodies. Imaging for suspected insulinoma CT - MRI - Endoscopic ultrasonography (EUS) - Arterial stimulation venous sampling - Intraoperative ultrasonography ```